Medical Billing & Revenue Cycle Management Services
Comprehensive medical billing and revenue cycle management services, tailored to your practice. FZ Digital Solutions provides human-managed medical billing and RCM for U.S. healthcare providers, delivered by a dedicated billing team and configured around your payer mix, specialty and systems.
- Advance Eligibility
- Prior Authorization
- Charge Creation
- Claim Submission
- A/R Follow-Up
- Denial Management
- Appeal Submission
- Patient Balance Verification
- Patient Statements
- Payment Posting (Patient, ERA/EOB)
What our managed medical billing service covers
Medical billing involves connected workflows, from eligibility verification and claims submission to payment posting and follow-up. Our service covers each of them:
Front-end revenue cycle and claims submission
Accurate claims depend on the work done before submission: confirming coverage, managing authorizations, entering charges and reviewing each claim before it goes out.
Eligibility & benefits verification
We verify patient eligibility and benefits so coverage questions can be identified before claims are submitted.
Prior authorization support
We provide administrative prior authorization support: coordinating requests, tracking their status, following up with payers and supporting authorization-related appeals. Clinical decisions remain with the provider, and approval decisions rest with the payer.
Charge capture, charge entry & documentation-based coding
We capture and enter charges from your encounters. When coding is included in your scope of service, it is documentation-based: codes and modifiers follow the provider's documentation, and we don't make code changes the documentation doesn't support.
Claim scrubbing & submission
We scrub claims before submission, and we reconcile billing-ready encounters and charges against submitted claims to help identify missing or duplicate submissions. We also track clearinghouse and payer acceptance acknowledgments, not just rejections.
EDI rejections, electronic & required paper claims
We work EDI rejections so they can be corrected and resubmitted. Claims are submitted electronically, and on paper where a payer requires it.
A/R follow-up, denials and appeals
Accounts receivable follow-up
We prioritize outstanding claims by age, payer, balance, status, and filing and appeal deadlines, and separately identify high-dollar claims where appropriate. Pending claims are followed up at appropriate intervals until there's a decision or a clear next action. Payer calls are documented with reference details, dates, status and notes where available.
Denial management
We review each denial's reason and act on it, including:
- Medical necessity denials: coordinated with provider documentation.
- Non-covered services: following the appropriate payer or patient-responsibility workflow.
- Bundling, incidental and modifier denials: reviewed against documentation, coding and payer rules.
- Duplicate denials: researched before any resubmission.
- Provider enrollment denials: checked against enrollment status and effective dates.
We also track recurring denials and share what we see (documentation, coding, eligibility or authorization patterns) with your practice to help reduce repeat issues.
Corrected claims, reconsiderations & appeals
When a claim needs to be corrected or challenged, we prepare corrected claims, reconsiderations and appeals with the supporting documents the case calls for. We track payer-specific appeal deadlines, and pursue further appeal levels when they're available after an adverse decision. Outcomes are decided by the payer and are never guaranteed.
Payment posting, reconciliation and patient billing
ERA/EOB payment posting & reconciliation
We post payments from ERAs and EOBs and keep posting reconciled:
- Zero-pay remittances are reviewed for denial or adjustment reasons and routed to the right work queue.
- Received remittances are tracked so available ERA/EOB records aren't missed.
- EFT deposits are reconciled with remittances where applicable.
Month-end reconciliation or closing reviews follow your practice's requirements.
Underpayment review
Using the contracted or expected allowed amounts you provide, we compare posted payments to identify potential underpayments for follow-up.
Credit balances, overpayments & recoupments
We review credit balances, overpayments and payer recoupments under the payer's rules. Refunds are made only with your practice's approval, and we keep the related account records.
Patient statements, payment plans & billing inquiries
We send patient statements on the schedule you agree, support payment plans, answer patient billing inquiries and post patient payments to the correct accounts. If a balance remains unresolved, it is referred to an external collection agency only after provider approval. We aren't a collection agency ourselves.
Provider credentialing and payer enrollment support
Enrollment, CAQH, PECOS & payer contracting support
- Individual provider enrollment and, where applicable, group or practice enrollment.
- Enrollment and billing-readiness workflows when a provider joins or a practice adds a location.
- Monitoring of payer requests, effective dates and application status after submission.
- Provider and payer status tracking for applicable multi-provider and group clients.
- CAQH and PECOS support, and payer contracting support.
- Applicable payer and system updates for provider terminations, when you request them.
- Handling of enrollment-related denials.
ERA/EFT enrollment
We help set up electronic remittance (ERA) and electronic funds transfer (EFT) enrollment with payers.
Payers make all enrollment decisions. State medical and professional licensing remains the provider's responsibility and is not part of our service.
Payers, specialties and switching billing providers
Payers & billing scenarios
We bill Medicare, Medicaid, commercial, Workers' Compensation and Personal Injury claims, in-network and out-of-network, and handle secondary insurance and coordination of benefits.
Specialties & provider types
We work with individual providers, group practices, multi-provider groups and practices with multiple locations. Specialty experience includes Family Medicine, Internal Medicine, Cardiology, Behavioral Health, Psychiatry, Physical Therapy, Chiropractic, Pain Management and Nephrology, as well as DME suppliers. Workflows are configured around each client's payer mix, specialty, systems and requirements.
Switching billing providers & legacy A/R
When transitioning billing providers, outstanding claims and legacy A/R need careful review and a documented work plan.
- Legacy A/R takeover: during onboarding, we inventory open claims, denials, appeals and outstanding A/R, and build a work plan.
- Assessment, not automatic write-offs: older claims are assessed against payer rules, filing limits, appeal rights, claim status and documentation.
- Transition support: where needed, we coordinate reports, access and outstanding-work handover with your previous billing company or internal team.
- Fee schedules: we update revised contracted fee schedules in the applicable systems.
Recovery of older balances is never guaranteed.
Reporting, quality and how the service is delivered
Reporting options
Reporting can be set up daily, weekly, monthly, quarterly, half-yearly or yearly, depending on your engagement. Reports and reviews cover collections, submitted claims, A/R aging, denials, appeals and patient balances.
Quality review & KPI tracking
Billing work goes through internal quality review. We track the metrics that matter to your practice, such as collections, A/R aging, denial rate, first-submission payment performance and payment turnaround, and discuss them with you in periodic performance reviews. Each client has an assigned manager, and difficult claims or payer issues follow a clear escalation path from biller to manager or senior team, and to your practice when needed.
Human-managed billing, with AI optional
Our managed billing service can be delivered entirely by people. AI tools are optional and used only where they fit your requirements. Custom AI agents and workflow automation are a separate service, never a requirement for billing clients.
Protecting patient information
We sign a Business Associate Agreement before any PHI-related work begins. Access is assigned and limited to each team member's clients and work, and our team uses multi-factor authentication and client-approved secure communication channels. Company-managed devices are used for our medical billing operations. HIPAA training is provided at onboarding and every year.
Pricing and engagement
Every practice's scope is different, so pricing is set per engagement, based on your scope and mutually agreed terms. Contract terms are agreed with each client.
Frequently asked questions
What does a medical billing and RCM service do?
A medical billing and revenue cycle management service handles the work between patient care and payment: eligibility checks, charge entry, claim submission, payment posting, A/R follow-up, denials, appeals and patient billing. FZ Digital Solutions manages this for U.S. healthcare providers as a comprehensive, human-managed service.
What is the role of revenue cycle management in healthcare?
Revenue cycle management connects a practice's clinical work to the payments it receives. It covers verifying coverage, submitting claims, following up on unpaid and denied claims, posting payments and managing patient balances, so that billable services are pursued through to resolution.
What are the main stages of the revenue cycle?
The revenue cycle is commonly described in stages: eligibility and authorization, charge capture and coding, claim submission, payment posting, A/R follow-up and denial management, and patient billing. Credentialing and enrollment sit alongside these stages, because a provider must be enrolled with a payer to be paid by it. Our service covers each of these areas.
What is medical coding and billing?
Medical coding translates the services documented by a provider into standard codes; billing uses those codes to prepare and submit claims and follow them to payment. When coding is included in your scope, our coding is documentation-based, so codes and modifiers follow the provider's documentation.
How is medical billing priced?
Pricing depends on your practice's scope and mutually agreed terms. We don't publish set prices; request a custom quote for your practice.
Do you handle provider credentialing and licensing?
We support provider credentialing and payer enrollment, including CAQH, PECOS and ERA/EFT enrollment. State medical and professional licensing remains the provider's responsibility and isn't part of our service.
Can you take over old A/R from our previous billing company?
Yes. We inventory open claims, denials, appeals and outstanding A/R, assess older claims against payer rules, filing limits and appeal rights, and build a work plan. Where needed, we coordinate the handover with your previous billing company or internal team. Recovery is never guaranteed.
Which payers do you bill?
Medicare, Medicaid, commercial, Workers' Compensation and Personal Injury claims, in-network and out-of-network, including secondary insurance and coordination of benefits.
How often will we receive reports?
Reporting can be daily, weekly, monthly, quarterly, half-yearly or yearly. The frequency is agreed for your engagement.
Do you use AI in billing?
Only if you want it. Our managed billing service can be delivered entirely by people, and AI tools are optional.
Can you guarantee payments, approvals or appeal outcomes?
No. Payers make coverage, authorization, payment and appeal decisions. We manage each step carefully and document the work, but we never guarantee outcomes.
Request a custom quote
Email us a few details about your practice, specialty, payer mix and where you need help.
Please do not send patient information or PHI by email.
Email us: sales@fzdigitalsolutions.com · contact@fzdigitalsolutions.com